Patient Sign-In Sheets

While the patient sign-in sheet is used at the front desks of most clinicians' offices, many doctors do not have a clear understanding of its legal importance. Contrary to what the lay public may believe, it is not just used to track a patient's arrival.¹

The patient sign-in sheet protects the doctor. This important document proves the patient was in the office on a particular date. This is necessary to avoid any question of fraud from insurance companies, including Medicare and state programs, such as Medicaid. Also, a disgruntled patient may claim that he was billed for services rendered on a day he was not in the doctor's office. A report to a disciplinary board because of such a claim can cause incredible problems.

Proof of the patient's presence cannot be achieved by any other method that is as simple and low-cost. Office notes, an appointment book with check marks next to a name, or even a signed patient's receipt, are not considered adequate proof, since they can be easily falsified. A sign-in sheet, on the other hand, preserves that patient's handwritten verification and the date of the office visit. To protect the clinician, the patient's signature must appear on a sheet with several other patients' signatures bearing the same date.

While sign-in sheets are an important part of office documentation, it seems obvious that displaying the day's patient list is a clear violation of a patient's privacy and confidentiality. Many experts warn that sign-in sheets violate the HIPAA privacy rule, as well as many states' privacy and confidentiality laws.^2-6 In addition, many patients are uncomfortable signing an open sign-in sheet.

The clinician faces a dilemma: We need the sign-in sheet to protect us, but it violates patient confidentiality and privacy laws. Presently, at least three companies are taking different approaches to solve this problem and comply with states privacy laws and the new federal HIPAA laws that go into effect April 2003.

Several companies are developing new ways to sign in: one that's similar to the old pegboard accounting set up with leafed sheets that are torn off after the patient signs-in; one that's a peel-off label design;⁸ and one that's two sheets of carbonless duplication paper similar to credit card receipts, but thicker, using a simple ballpoint pen and a chisel-point marker.

Whatever system you decide on, protecting your patients' privacy with the new generation of sign-in sheets makes sense. We should welcome them into our offices as a long overdo improvement. They will make your patients more comfortable and show that you care while allowing compliance with federal and state privacy laws.

References

1. The Chiropractic Forms and Sample Letter Book, pp. 15. Practice Makers Products, Inc., Palmerton, PA 18071.
2. Ravitz KS. Complying with privacy regulations. PT Magazine November 2001;9(11):20-22.
3. Jahn W. HIPAA issues privacy rule. Florida Chiropractic Journal September-October 2001:26-27.
4. Hayden R. HIPAA, HIPAA, hooray! Florida Chiropractic Journal November-December 2001:14-15.
5. Private correspondence with Shep Willis, editor of Eli Research's Health Information Compliance Alert Newsletter.
6. Private conversation with Representative Gayle Harrell, member of the Florida House Committee on Health Regulations.
7. Private conversations with NEBS.
8. Private conversations with Medical Arts Press.